Factors Predictive of Remission of Chronic Anterior Uveitis

Abstract Purpose To estimate the incidence of medication-free remission of chronic anterior uveitis; to identify predictors thereof. Design Retrospective cohort study Participants Patients diagnosed as having anterior uveitis for greater than 3 months followed at United States tertiary uveitis care facilities Methods Retrospective cohort study based on standardized chart review. Estimation of remission incidence and identification of associated predictors used survival analysis. Main Outcome Measures Incidence of medication-free remission. For the primary analysis, remission was defined as inactive uveitis off treatment at all visits spanning an interval of at least 90 days or—for patients who did not return for follow-up after 90 days—remaining inactive without receiving suppressive medications at all of their last visits. Association of factors potentially predictive of medication-free remission also was studied. Results 2795 eyes of 1634 patients with chronic anterior uveitis were followed over 7936 eye-years (4676 person-years). The cumulative medication-free, person-year remission incidence within 5 years was 32.7% [95% Confidence Interval (CI), 30.4% - 35.2%]. Baseline clinical factors predictive of less remission included longer duration of uveitis at presentation [adjusted hazard ratio (aHR), 0.61; 95% CI, 0.44 - 0.83; for 2 - 5 years vs. less than 6 months], bilateral uveitis (aHR, 0.75, 95% CI, 0.59 – 0.96), prior cataract surgery (aHR, 0.70; 95% CI 0.56 – 0.88) and glaucoma surgery (aHR, 0.63; 95% CI, 0.45 – 0.90). Two time-updated characteristics were also predictive of less remission: keratic precipitates (aHR, 0.36; 95% CI 0.21– 0.60) and synechiae (aHR, 0.62; 95% CI, 0.41 - 0.93). Systemic diagnosis with juvenile idiopathic arthritis and spondyloarthropathy also were associated with less remission. Older age at presentation was associated with higher incidence of remission (aHR, 1.29; 95%, CI 1.02 – 1.63, for age ≥ 40 years vs. Conclusions Approximately one-third of chronic anterior uveitis cases remit within five years. Longer duration of uveitis, younger age, bilateral uveitis, prior cataract surgery, glaucoma surgery, presence of keratic precipitates and synechiae, and systemic diagnoses of juvenile idiopathic arthritis and spondyloarthropathy predict less remission; cases with these factors should be managed taking into account the higher probability of a longer disease course.